High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study

Abstract Objective: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. Methods: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge'sg. Results: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). Conclusion: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study.

OBJECTIVE: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. METHODS: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g. RESULTS: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). CONCLUSION: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

Characterization of simulation centers and programs in Latin America according to the ASPIRE and SSH quality criteria.

BACKGROUND: Latin American clinical simulation has had an important development; there are no studies that characterize simulation centers and programs in the entire region. The aims of this work are to characterize the current state of simulation-based education in the health sciences, to determine the structure of Latin American simulation centers in terms of teaching, research, and continuing medical education (CME), as well as to determine the perception of quality based on international standards of simulation practices for the directors of Latin American centers. METHODS: A quantitative, descriptive, cross-sectional study with a demographic questionnaire and a Likert-type survey was conducted to the directors of the simulation centers found in Latin America. RESULTS: Four hundred eight simulation centers were documented, the survey was answered by 240 directors, and the data from 149 were complete responses on the 42 quality self-perception scale and considered valid on further analyses related to the quality of the programs. Most of the centers that responded correspond to Chile, Brazil, and Mexico (37.5%, 18.1%, 12.7%). 84% of the centers are university-based, and 71% of the centers are medium-sized, with less than 10 instructors (54%). The directors are mostly women (61.7%), medical doctors (50%), and nurses (40%), with clinical specialization (37%), master's degree (53%), and doctorate (13%). 75% have completed a simulation instructor course, and 6% have developed a fellowship. Most consider the maintenance of international quality standards to be relevant in their centers, mainly in reflective training techniques, ethical aspects, and adequate learning environments. CONCLUSIONS: Simulation-based education in health sciences has had an increasing development in Latin America, within a university environment, in an important academic specialization process that seeks to adhere to high-quality standards to improve training and development of clinical skills, human factors, and critical thinking. We recommend starting accreditation processes in Latin America and studies that measure the quality of simulation-based education in our region, based on objective observations more than in self-reporting.

Errores en la prescripción de medicación durante la realización de reanimaciones y otras urgencias pediátricas simuladas / Mistakes in drug prescription during simulated pediatric resuscitations and other urgency procedures

Introducción. La probabilidad de incurrir en errores en la prescripción de drogas es importante en pediatría y aumenta considerablemente en situaciones de emergencia. Material y métodos. Estudio prospectivo observacional. Se analizaron las prescripciones escritas durante 23 jornadas de simulación de urgencias pediátricas. Resultados. En 94 casos simulados, participaron 96 médicos. Se analizaron 44 prescripciones en papel (48%), que incluían 120 dosis. Se hallaron errores en 12 medicaciones (10%, IC 95%: 5,517,2). Se atribuyó como principal causa de error el estrés. Conclusiones. La ocurrencia de errores en la prescripción de medicamentos durante las sesiones de simulación de emergencias pediátricas fue frecuente.

Introduction. The probability of making mistakes in the prescription of medicines is high in pediatrics, and substantially increases in emergency situations. Material and methods. This prospective observational study analyzed the prescriptions issued by physicians during 23 cardiopulmonary resuscitation pediatric emergency training sessions. Results. During 94 simulated cases, 96 physicians participated. Forty-four prescriptions on paper were analyzed (48%) including 120 doses. Twelve medication errors were found (10%, CI 95%: 5.517.2). Stress was identified as the primary cause of prescription mistakes. Conclusions. Drug prescription mistakes frequently occurred during pediatric emergency simulations.

[Mistakes in drug prescription during simulated pediatric resuscitations and other urgency procedures]. / Errores en la prescripción de medicación durante la realización de reanimaciones y otras urgencias pediátricas simuladas.

INTRODUCTION: The probability of making mistakes in the prescription of medicines is high in pediatrics, and substantially increases in emergency situations. MATERIAL AND METHODS: This prospective observational study analyzed the prescriptions issued by physicians during 23 cardiopulmonary resuscitation pediatric emergency training sessions. RESULTS: During 94 simulated cases, 96 physicians participated. Forty-four prescriptions on paper were analyzed (48%) including 120 doses. Twelve medication errors were found (10%, CI 95%: 5.517.2). Stress was identified as the primary cause of prescription mistakes. CONCLUSIONS: Drug prescription mistakes frequently occurred during pediatric emergency simulations.

INTRODUCCIÓN: La probabilidad de incurrir en errores en la prescripción de drogas es importante en pediatría y aumenta considerablemente en situaciones de emergencia. MATERIAL Y MÉTODOS: Estudio prospectivo observacional. Se analizaron las prescripciones escritas durante 23 jornadas de simulación de urgencias pediátricas. RESULTADOS: En 94 casos simulados, participaron 96 médicos. Se analizaron 44 prescripciones en papel (48%), que incluían 120 dosis. Se hallaron errores en 12 medicaciones (10%, IC 95%: 5,517,2). Se atribuyó como principal causa de error el estrés. CONCLUSIONES: La ocurrencia de errores en la prescripción de medicamentos durante las sesiones de simulación de emergencias pediátricas fue frecuente.

Assessment of central venous catheterization in a simulated model using a motion-tracking device: an experimental validation study.

BACKGROUND: Central venous catheterization (CVC) is a basic requirement for many medical specialties. Simulated training in CVC may allow the acquisition of this competency but few reports have established a valid methodology for learning and acquiring procedural skills for CVC. This study aims to validate the use of a tracking motion device, the imperial college surgical assessment device (ICSAD), by comparing it with validated global rating scales (GRS) to measure CVC performance in a simulated torso. METHODS: Senior year medical students, first and last year residents (PGY1, LYR), and expert anesthesiologists performed a jugular CVC assessment in a simulated model (Laerdal IV Torso). A validated GRS for objective assessment of technical skills and motion analysis by ICSAD was used. Statistical analysis was performed through Mann-Whitney and Kruskal-Wallis tests for construct validity and Spearman correlation coefficients between the ICSAD and GRS scores for concurrent validity between both. RESULTS: 32 subjects were recruited (10 medical students, 8 PGY1, 8 LYR and 8 experts). Total path length measured with ICSAD and GRS scores were significantly different between all groups, except for LYR compared to experts (p = 0.664 for GRS and p = 0.72 for ICSAD). Regarding jugular CVC procedural time, LYR and experts were faster than PGY1 and MS (p < 0.05). Spearman correlation coefficient was -0.684 (p < 0.001) between ICSAD and GRS scores. CONCLUSIONS: ICSAD is a valid tool for assessment of jugular CVC since it differentiates between expert and novice subjects, and correlates with a validated GRS for jugular CVC in a simulated torso.